| NPI | 1366986242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY F342464-1) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9250352) |
| Enumeration Date | 2016-12-12 |
| Last Update Date | 2019-12-18 |